Provider Demographics
NPI:1841245750
Name:BLANKENSHIP, GEOFFREY M (PA)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:M
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3804
Mailing Address - Country:US
Mailing Address - Phone:304-399-6727
Mailing Address - Fax:304-399-6726
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3804
Practice Address - Country:US
Practice Address - Phone:304-399-6727
Practice Address - Fax:305-399-6726
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA972363A00000X
WV01162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001807775OtherBLUE CROSS BLUE SHIELD
KY7100014080Medicaid
WVP00372230OtherRR MEDICARE
WV1841245750Medicaid
OH0188020Medicaid
WV1069705OtherWORKERS COMPENSATION